Provider Demographics
NPI:1770898819
Name:DELAHOZ, NORMA (PA)
Entity type:Individual
Prefix:MS
First Name:NORMA
Middle Name:
Last Name:DELAHOZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11109 66TH RD APT 1C
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-8220
Mailing Address - Country:US
Mailing Address - Phone:212-939-8063
Mailing Address - Fax:212-939-8038
Practice Address - Street 1:506 LENOX AVE BLDG 12TH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:718-541-2778
Practice Address - Fax:212-939-8039
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010227-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010227Medicaid